Quintiliani-Johns v Secretary, Department of Education

DETERMINATION OF APPEAL PANEL
CITATION:	Quintiliani-Johns v Secretary, Department of Education [2025] NSWPICMP 158
APPELLANT:	Flavia Quintiliani-Johns
RESPONDENT:	Secretary, Department of Education
APPEAL PANEL
MEMBER:	Parnel McAdam
MEDICAL ASSESSOR:	John Lam-Po-Tang
MEDICAL ASSESSOR:	Professor Nicholas Glozier
DATE OF DECISION:	12 March 2025
CATCHWORDS:	WORKERS COMPENSATION - Supreme Court remitter following Quintiliani-Johns v Secretary, Department of Education; challenge to assessment under psychiatric impairment rating scale (PIRS) of self-care and personal hygiene, and social and recreational activities; consideration of clause 11.10 of the SIRA NSW Workers Compensation Guidelines for the Evaluation of Permanent Impairment, 4th ed 1 March 2021 (the Guidelines); whether deduction could be calculated in accordance with the PIRS; Held – percentage of pre-existing impairment cannot be assessed under PIRS; deduction of one-tenth made; Medical Assessment Certificate revoked.

BACKGROUND TO THE APPLICATION TO APPEAL

This matter has a more extensive background than usual due to judicial review proceedings. The present appeal follows a remitter from the Supreme Court.
On 4 August 2023, the appellant, Ms Quintiliani-Johns lodged an Application to Appeal Against the Decision of a Medical Assessor. The medical dispute was assessed by Clayton Smith, a Medical Assessor, who issued a Medical Assessment Certificate (MAC) on 7 July 2023.
The appellant relies on the following grounds of appeal under s 327(3) of the Workplace Injury Management and Workers Compensation Act 1998 (the 1998 Act):
· the assessment was made on the basis of incorrect criteria, and
· the MAC contains a demonstrable error.
The delegate is satisfied that, on the face of the application, at least one ground of appeal has been made out. The Appeal Panel has conducted a review of the original medical assessment but limited to the ground(s) of appeal on which the appeal is made.
The appeal was referred to a differently constituted Appeal Panel, who issued a decision on 23 November 2023. That Appeal Panel revoked the MAC on the basis of a rounding error, for a final whole person impairment assessment of 5%.
The appellant sought judicial review of the decision of the Appeal Panel. In a decision dated 25 September 2024 (Quintiliani-Johns v Secretary, Department of Education [2024] NSWSC 1200 (Quintiliani-Johns)), her Honour Mitchelmore J made the following relevant orders:
“(a) Set aside the decision of the Appeal Panel dated 23 November 2023, and the Certificate of the Personal Injury Commission dated 9 January 2024.
(b) The matter be remitted to the President of the Personal Injury Commission for referral to a differently constituted appeal panel under s 328 of the Workplace Injury Management and Workers Compensation Act 1998 (NSW) to be determined according to law.”
On 30 October 2024, the Appeal Panel was constituted to determine the matter according to law.
Rule 128 of the Personal Injury Commission Rules 2021 (the PIC Rules) and Procedural Direction PIC7 - Appeals, reviews, reconsiderations and correction of obvious errors in medical disputes set out the practice and procedure in relation to the medical appeal process under s 328 of the 1998 Act. An Appeal Panel determines its own procedures in accordance with r 128(1) of the PIC Rules.
The assessment of permanent impairment is conducted in accordance with the SIRA NSW Workers Compensation Guidelines for the Evaluation of Permanent Impairment, 4^th ed
1 March 2021 (the Guidelines).

RELEVANT FACTUAL BACKGROUND

The factual background to this matter has been set out in detail in the MAC and in Quintiliani-Johns. In summary, Ms Quintiliani-Johns was employed as a teacher librarian with the respondent (at Callaghan College). She took a period of leave for a year, before returning to her substantive role. In the interim, there had been radical changes to the library system within the school, causing her to develop symptoms of anxiety. She spoke to the principal and was questioned about her performance.
A decision was then made to move the location of the library, causing her anxiety to worsen. On 6 February 2020, she was informed she was medically unfit to work. She met with the principal and head teacher on 24 February 2020, for a performance meeting. A letter was provided and then an official warning on 5 May 2020. She was certified unfit to work, and then returned to work in December 2020 but could not cope.
Two claims were made on the respondent, both of which were disputed, largely pursuant to s 11A of the Workers Compensation Act 1987. Proceedings were commenced in the Commission, claiming weekly benefits and lump sum compensation. Two dates of injury were provided, being deemed dates on 17 March 2020 and 21 April 2021, with the same injury description.
The matter proceeded to a Member, and was resolved by consent. On 31 May 2023, a Certificate of Determination was issued resolving the claim for weekly compensation benefits and remitting the dispute about whole person impairment to a Medical Assessor.
On 7 July 2023, the MAC was issued, providing an assessment of whole person impairment of 9% under the Psychiatric Impairment Rating Scales (PIRS), and a deduction of one half, for a final whole person impairment assessment of 4% (which should have been rounded up to 5%).
The matter then proceeded to an appeal and judicial review, as set out above. The Appeal Panel issued a preliminary review on 6 December 2024, determining that it was necessary to re-examine the worker, and calling for the production of certain medical records. The appellant complied with the direction to produce clinical records, and the appellant was re-examined on 10 February 2025 by Medical Assessor Lam-Po-Tang.

PRELIMINARY REVIEW

The Appeal Panel conducted a preliminary review of the original medical assessment in the absence of the parties and in accordance with the Procedural Direction PIC7.
As a result of that preliminary review, the Appeal Panel determined that the worker should undergo a further medical examination due to the issues raised on appeal, as well as the period of time that had elapsed since the MAC was issued. For abundant clarity, at the time of issue of the preliminary review direction, the Appeal Panel was satisfied that the MAC contained a demonstrable error.

EVIDENCE

Documentary evidence

The Appeal Panel has before it all the documents that were sent to the Medical Assessor for the original medical assessment and has taken them into account in making this determination.
The Appeal Panel also called for the production of medical records pursuant to s 324(1)(b) of the 1998 Act, a power granted to the Appeal Panel by virtue of s 324(4). Those records being:

(a)    clinical records including correspondence generated and received from Brunker Road General Practice;
(b)    clinical records including correspondence generated and received from Dr Catherine Faehrmann or any other psychiatrist working in private practice who has treated the worker, and
(c)    clinical records including correspondence generated and received from Hunter New England Local Health District.

Those documents were produced by the appellant of 4 February 2025. The Appeal Panel have considered that material in determining the dispute.

Further medical examination

Medical Assessor John Lam-Po-Tang of the Appeal Panel conducted an examination of the worker on 10 February 2025 and reported to the Appeal Panel.

Medical Assessment Certificate

The parts of the medical certificate given by the Medical Assessor that are relevant to the appeal are set out, where relevant, in the body of this decision.

SUBMISSIONS

Both parties made written submissions. They are not repeated in full, but have been considered by the Appeal Panel.
In summary, the appellant submits that the Medical Assessor erred in respect of the PIRS of self care and personal hygiene as well as social and recreational activities, and on each occasion should have assessed one class higher. The appellant submits that the Medical Assessor misunderstood the events that caused the worker’s injury, wrongly attributing some of the symptoms to her pre-event psychological status pursuant to s 323 of the 1998 Act, or alternatively that the appropriate deduction should be 1/10^th.
In reply, the respondent submits that generally, it is the responsibility of the Medical Assessor to interview the worker and provide an assessment based on the findings as at the date of examination with consideration to the available evidence. The respondent submits that the assessment of self care and personal hygiene is not inconsistent with the history recorded by the Medical Assessor at page 5 of the MAC, as well as within the supporting documents. In respect of social and recreational activities, the respondent submits that the Medical Assessor provided adequate reasons, not inconsistent with the history provided by the Medical Assessor.
In respect of the s 323 deduction, the respondent submits that the Medical Assessor has provided a detailed history and critical analysis of the appellant’s pre-existing condition. The respondent submits that s 11.10 of the Guidelines is inconsistent with s 323 of the 1998 Act, and the Medical Assessor was correct to assess the proportion of the impairment resulting from the pre-existing condition. There is substantial evidence to support a deduction greater than 1/10^th.

FINDINGS AND REASONS

The procedures on appeal are contained in s 328 of the 1998 Act. The appeal is to be by way of review of the original medical assessment but the review is limited to the grounds of appeal on which the appeal is made per Basten JA in Queanbeyan Racing Club Ltd v Burton [2021] NSWCA 304 at [26]:
“Secondly, s 328(2) requires that the review ‘is limited to the grounds of appeal on which the appeal is made.’ Because the gateway function of the Registrar is satisfied if ‘at least one of the grounds’ has been made out, it appears that the Appeal Panel is not limited to the ground held by the Registrar to have been made out, but may consider all grounds of appeal raised in the appellant’s application. On the other hand, it is clear that the Appeal Panel is not permitted to look for errors which are not part of the grounds of appeal on which the appeal is made.”
In Campbelltown City Council v Vegan [2006] NSWCA 284 the Court of Appeal held that the Appeal Panel is obliged to give reasons. Where there are disputes of fact it may be necessary to refer to evidence or other material on which findings are based, but the extent to which this is necessary will vary from case to case. Where more than one conclusion is open, it will be necessary to explain why one conclusion is preferred. On the other hand, the reasons need not be extensive or provide a detailed explanation of the criteria applied by the medical professionals in reaching a professional judgement.
The appellant’s submissions can be characterised into three grounds of appeal, with the submissions identifying different errors within each ground. The decision of Mitchelmore J in Quintiliani-Johns provides guidance for the interpretation of the issues raised on appeal, although of course the matter has been remitted to the Appeal Panel to determine according to law.

Assessments under the PIRS

The legislative framework was analysed in detail by Mitchelmore J in Quintiliani-Johns. Nevertheless it is relevant to set out some critical aspects of the assessment process undertaken in considering the appeal.
All assessments of permanent impairment are undertaken “in accordance with” the Guidelines (s 322(1) of the 1998 Act). There are six scales, known as the PIRS, “each of which evaluates an area of functional impairment” (cl 11.11 of the Guidelines). The scales give examples of activities that are to be taken into account when assessing the class of functional impairment. The class descriptors range from no or minor deficit, through to totally impaired. This is explained by Campbell J in Ferguson v State of New South Wales [2017] NSWSC 887:
“Class 1 relates to a situation where there is no psychological deficit, or a minor deficit attributable to the normal variation in the general population. Class 5 pertains to a person who is totally impaired by his injury, and the classes between are in an ascending order of impairment.”
Each area of functional impairment provides a series of examples, that are “examples only” (cl 11.12). In Jenkins v Ambulance Service of New South Wales [2015] NSWSC 633, Garling J considered the construction of the PIRS in the context of the examples given. He provided some commentary on the construction of the Guidelines:
“The submission of the plaintiff that, in assigning a class of impairment to each scale, the AMS is restricted only to the examples of activities listed in the tables or, alternatively, to those activities as a minimum, cannot be accepted.” (at [57])
Also raised on appeal is s 323 of the 1998 Act. Although the section is not explicitly referred to, cl 11.10 deals with pre-existing impairment in the following terms:
“To measure the impairment caused by a work-related injury or incident, the psychiatrist must measure the proportion of WPI due to a pre-existing condition. Pre-existing impairment is calculated using the same method for calculating current impairment level. The assessing psychiatrist uses all available information to rate the injured worker’s pre-injury level of functioning in each of the areas of function. The percentage impairment is calculated using the aggregate score and median class score using the conversion table below. The injured worker’s current level of WPI% is then assessed, and the pre-existing WPI% is subtracted from their current level, to obtain the percentage of permanent impairment directly attributable to the work-related injury. If the percentage of pre-existing impairment cannot be assessed, the deduction is 1/10th of the assessed WPI.”
Clause 11.10 of the Guidelines has been held to be inconsistent with s 323(1) and invalid (in certain factual circumstances, namely in that case where the pre-existing condition was asymptomatic) per Simpson AJ in Marks v Secretary, Department of Communities and Justice (No 2) [2021] NSWSC 616 (Marks No 2):
“I have therefore concluded that Guideline 11.10 of the Workers Compensation Guidelines is, to the extent that it excludes, in the application of s 323(1) of the WIM Act to any psychiatric or psychological impairment, consideration of any contribution made to the impairment by a pre-existing but asymptomatic condition, inconsistent with s 323(1) and invalid.”
The issue was addressed in obiter in Quintiliani-Johns at [74] and [75]. There was no submission from the respondent that cl 11.10 was invalid where a pre-existing condition was symptomatic before the onset of a work injury. The appropriate process in those circumstances, applicable to the Appeal Panel in the present case, is:
“In order to ascertain what, if any, proportion of the plaintiff’s current level of WPI was due to her pre-existing condition, the Guidelines required the medical assessor to undertake an assessment of the plaintiff’s pre-injury level of functioning, by reference to the PIRS. If that could not be assessed, the Guidelines prescribed that the deduction was to be one-tenth of her assessed WPI (it was not submitted that this was inconsistent with s 323(2)).”

Self care and personal hygiene

The Medical Assessor provided an assessment of class 2 under this PIRS. The appellant submits that he should have assessed class 3.
Table 11.1 in the Guidelines provides the criteria for assessment under this PIRS. Class 2 represents mild impairment and class 3 moderate impairment:

Class 2	Mild impairment: Able to live independently; looks after self adequately, although may look unkempt occasionally; sometimes misses a meal or relies on take-away food.
Class 3	Moderate impairment: Can't live independently without regular support. Needs prompting to shower daily and wear clean clothes. Does not prepare own meals, frequently misses meals. Family member or community nurse visits (or should visit) 2-3 times per week to ensure minimum level of hygiene and nutrition.

The appellant refers to the content of her statement dated 8 August 2022. The appellant submits that the section in the MAC referring to her statement does not refer to the description of how the injury affects her, nor has the Medical Assessor appropriately considered the history he recorded in the body of the MAC. The appellant submits that the reasons given in the PIRS table make no reference to the worker skipping meals and dependency on her husband to cook. Those reasons are provided on page 17:
“Ms Quintiliani-Johns can live independently but is less concerned about her appearance, sometimes skips showering or brushing her teeth and does not maintain her self-care to the pre-injury standard. She is able to maintain a minimal level of hygiene and nutrition independently.”
In Quintiliani-Johns the error of the previous Appeal Panel was characterised as one of a failure to consider a reasonably articulated argument.
In respect of the appellant’s submission that the Medical Assessor failed to consider her statement, that cannot be accepted. He provides, as the appellant submits a “very detailed section of the MAC containing ‘brief comments’ on the evidence”. This traverses over a period of six pages. The Appeal Panel agrees that this section of the MAC is very thorough. The Medical Assessor clearly read Ms Quintiliani-Johns’ statements as he describes in detail what they contain. A failure to refer to a specific part of that statement is not in error.
A Medical Assessor is an administrative decision maker. The reasons of an administrative decision maker are not meant to be construed minutely and finely (Minister for Immigration and Ethnic Affairs v Wu Shan Liang (1996) 185 CLR 259 at 272; [1996] HCA 6):
“These propositions are well settled. They recognise the reality that the reasons of an administrative decision-maker are meant to inform and not to be scrutinised upon over-zealous judicial review by seeking to discern whether some inadequacy may be gleaned from the way in which the reasons are expressed.”
Although dealing with different legislation, it is relevant that a decision maker is not required to refute evidence on a line-by-line basis Re: The Minister for Immigration and Multicultural Affairs; Ex parte Durairajasingham [2000] HCA 1 (at [65]):
“But that said, it is not necessary for the Tribunal to give a line-by-line refutation of the evidence for the claimant either generally or in those respects where there is evidence that is contrary to findings of material fact made by the Tribunal.”
Were the appellant’s submission limited to a failure to consider the specific aspects of the worker’s statement, this ground of appeal would not be made out. A Medical Assessor is entitled to reach factual findings that differ from those set out in a statement (or other evidence). Any alternative conclusion would almost make the assessment process otiose; an injured worker could simply set out symptoms and impairment consistent with the examples given in the Guidelines that would bind the Medical Assessor. To take this point ad absurdum, it could extend to providing examples consistent with class 5 in every PIRS, to a total of 100% whole person impairment. It would do away with clinical judgment. This is consistent with the “pre-eminence of the clinical observations” as discussed by Campbell J in Ferguson v State of New South Wales and Ors [2017] NSWSC 887 at [33].
However, the appellant’s submission is more nuanced; it is submitted that the Medical Assessor failed to consider both those aspects of the statement and the history he recorded in the MAC in reaching his conclusion in respect of this ground. A failure to consider that history could constitute demonstrable error. A failure to apply the history recorded consistently with the Guidelines could constitute the application of incorrect criteria.

The history recorded in respect of self care and personal hygiene appears on page 5 of the MAC:
“She skips meals and has gained weight. She showers at least every second day and often skips a day. She usually brushes her teeth daily but sometimes skips a day. She has not had a dental check-up in the last 12 months. She had previously been more regular. She had a haircut six weeks ago, the first since Christmas. She used to have it cut more regularly. She said she has never been one to go to the beautician. She is indifferent to her appearance and manages the basics only. She wears the same jewellery because she cannot be bothered changing it. She has not been for an eye check for two years”
The Appeal Panel are satisfied that the Medical Assessor appropriately considered the history he recorded of restrictions in self care in the body of the MAC. The fact that the conclusion he reached was not higher is not itself an error.
As part of the re-examination process, including the application of s 323 of the 1998 Act, the Appeal Panel has considered this PIRS. The report as part of that re-examination will be set out and discussed below.

Social and recreational activities

The Medical Assessor assessed class 2 under this PIRS. The appellant submits that the correct assessment is class 3.
Table 11.2 provides the criteria for this PIRS. Relevantly:

Class 2	Mild impairment: Occasionally goes to such events eg without needing a support person, but does not become actively involved (eg dancing, cheering favourite team).
Class 3	Moderate impairment: Rarely goes out to such events, and mostly when prompted by family or close friend. Will not go out without a support person. Not actively involved, remains quiet and withdrawn.

The appellant refers to the contents of her statement, particularly her avoidance of being in community or social settings due to fear of running into someone from the school where she worked. The appellant also refers to the history recorded in the MAC relevant to social and recreational activities:
“Ms Quintiliani-Johns feels anxious about socialising. She feels that she cannot trust people anymore. She might go to her in-laws in the next suburb with her husband. She averages once a fortnight for a cup of tea and a chat, mostly accompanied by her husband. She may take herself to her psychiatrist appointment and visit on her way back but is usually accompanied. The dialectical behaviour therapy program is based at The James Fletcher Facility. Usually, her husband drives her, although occasionally, she drives alone.
She attends an Arts in Recovery program on the third Thursday of the month, which she resumed this year. She attends an arts program in Maitland called Journeys on the third Friday of the month. She drives herself to Arts in Recovery and catches the train to Maitland outside peak times. She has tried to go out with her husband but is concerned she will see someone she knows. She might go to a restaurant every three months. She talks to her friend on the phone occasionally, catches up with her cousin for yoga once a week, and has been three times this year.
She enjoys swimming. Her husband accompanies her to the Merewether Baths once or twice a week. She enjoys walking and likes to try to keep fit. She might walk alone locally once a week. She walks with her daughter occasionally, and they may go to the shops together.”
The history taken in this section is more extensive. It is also acknowledged that the history recorded under social activities/ADLs and in particular the sections quoted above may traverse different areas of functional impairment under the PIRS. Noting her Honour’s criticism of the previous Appeal Panel’s decision at [49], the Appeal Panel do not intend to summarise aspects of the Medical Assessor’s reasons.
The appellant submits that on the history taken by the Medical Assessor, the worker ought to have been assessed as class 3 impairment rather than class 2. The worker rarely goes out to social and recreational events and when she does, she has a support person. The appellant particularly disputes the statement in the PIRS table that the worker “regularly socialises with family and a few close friends”. The appellant submits that Ms Quintiliani-Johns is not engaging in a “social or recreational activity” when she interacts with them in the course of her daily life, and that walking with her daughter is not a “social or recreational activity”. The appellant also submits that the worker’s ability to function with family and friends is properly addressed under “social functioning”.
Although not explicitly particularised in their submissions, the above must only be read as a reference to Ballas v Department of Education (State of NSW) [2020] NSWCA 86 (Ballas). It is unfortunate that the appellant did not refer at all to that decision in their submissions. In Quintiliani-Johns it is clear that her Honour read it as such. The Appeal Panel agree and adopt that approach. Her Honour did not go further to suggest that the Medical Assessor’s reasons infringed on what was set out in Ballas at [93]-[94], that is that the Medical Assessor had characterised conduct in an impermissible way by wrongly assigning it to a different scale (in this case, the conduct set out above to the PIRS of social functioning).
Ballas, of course, as a decision of the Court of Appeal, represents binding authority on the Appeal Panel. It should always be remembered that caselaw must be applied according to the issues decided in that case. Basten JA in Lancaster v Foxtel Management Pty Ltd [2022] NSWSC 929 (Lancaster) provided caution on interpreting Ballas too widely:
“The plaintiff’s reading of Ballas would have surprising consequences. It would mean that every time a medical specialist considered under one scale an activity which a court determined properly fell under another scale, he or she committed jurisdictional error which could be the subject of review in the Supreme Court. The proposition that gambling (or running) may fall within the descriptor ‘social and recreational activities’ if carried out in company (whatever that might imply) but not if carried out alone, and the assessment by a medical specialist whom a court determined had failed to apply that distinction so as to render his or her determination a nullity would be a surprising consequence. It would involve reading down the term ‘recreational’ by reference to the generic and imprecise exemplars in the class descriptions, so as to impose a legal constraint on the valid exercise of power by the medical specialist. A similar exercise would potentially be available for each of the other scale descriptors.
Even if such an implausible reading of the joint reasons in Ballas were correct, it was not necessary for the determination in Ballas. In any event, no similar error is alleged to have occurred in the present case: the question here is whether the Appeal Panel erred in assigning a particular class (that is level of severity) in relation to conduct which concededly fell within the particular scales (or categories).”
Similar caution was expressed by Stern JA in Botha v Secretary, NSW Department of Customer Service [2024] NSWSC 781 (at [14]):
“Their Honours held, on the facts of that case, that the finding of the medical assessor that the worker ‘sees one friend regularly’ fell ‘squarely within the “social functioning (relationships)” scale’, and, by implication, not within the Social and Recreational PIRS: at [96]. It is important that this finding is not taken out of its own factual context. It should not be read as holding that social and recreational activities with friends, or even with one friend, cannot properly be characterised as going to the Social and Recreational PIRS. In Ballas, the worker submitted (and there is nothing to suggest that that submission was contradicted) that there was no reference in the history set out in the medical assessor’s certificate to the worker seeing the ‘one friend’, and it was not possible from the medical assessor’s assessment to know in what circumstances that contact occurred (as recorded in Ballas at [35], [81]). The dearth of information in Ballas to explain in what context the worker saw that one friend informs their Honours’ conclusion as to characterisation. The mere fact that the worker saw a friend regularly would not indicate that the occasion on which she did so was properly categorised as a social and recreational activity.”
The same can be said of the way the appellant attempts to characterise the reasons of the Medical Assessor in respect of this category. Nothing in Ballas prevents activities that are undertaken with family, should they have a “social or recreational” character to them, being properly considered under that PIRS. By cl 11.11 of the Guidelines, table 11.2 requires the evaluation of how the behavioural consequences of psychiatric disorder impair what social and recreational activities an injured person engages in, and in what manner and how frequently, whilst table 11.4, social functioning, is used to assess the quality of relationships and how they have been affected by the work injury being assessed.
That is not to say that the Medical Assessor has appropriately considered the history he took of Ms Quintiliani-Johns’ restrictions in respect of her social and recreational activities when reaching his conclusion in this PIRS. The Medical Assessor does make reference to irrelevant criteria in his reasons; the appellant’s attendance at a dialectical behaviour therapy group therapy program is not a social and recreational activity, but forms part of her treatment. The Medical Assessor has also failed to consider that Ms Quintiliani-Johns, to the extent that she engages in social activities, does so with or without a support person. Considering those factors, the Appeal Panel are satisfied that the MAC contains a demonstrable error and have conducted a re-assessment of this PIRS (and all others), which will be discussed below.

Section 323 deduction

The Medical Assessor made a deduction of one half of the impairment assessed pursuant to s 323 of the 1998 Act. The appellant submits that the deduction should have been 1/10^th. This is said to be on two bases – a factual error regarding diagnosis and an incorrect application of the Guidelines.
The Medical Assessor provides the following reasons for his conclusion in respect of s 323:
“DEDUCTION (IF ANY) FOR THE PROPORTION OF THE IMPAIRMENT THAT IS DUE TO PREVIOUS INJURY OR PRE-EXISTING CONDITION OR ABNORMALITY
a. In my opinion the worker suffers from the following relevant previous injuries, pre-existing conditions or abnormalities:
(i) Bipolar disorder type 1.
b. The previous injury, pre-existing condition or abnormality directly contributes to the following matters that were taken into account when assessing the whole person impairment that results from the injury, being the matters taken into account in 10a, and in the following ways:
(i) The history and documentation confirm that Ms Quintiliani-Johns has a pre-existing condition, specifically bipolar disorder type 1. This impacted her role and function at work leading up to the injury. In determining the burden of impairment and apportion of pre-existing conditions I considered Ms Quintiliani-Johns’ self-reported history, the documentation provided, documented collerateral history from her husband, the natural history of bipolar disorder type 1 and reports from several independent medical examiners.
(ii) Bipolar disorder type 1 substantially impacts the work related injury, is a major mental illness, and influenced her behaviour in the workplace.
c. Whilst the extent of the deduction is difficult or costly to determine the available evidence is that the deductible proportion is large and a deduction of one tenth is at odds with the available evidence. In my opinion the deductible proportion is 5/10 for the following reasons:
(i) The current impairment is a product of both a pre-existing psychological disorder and the effects of the subject injury. Ms Quintiliani-Johns’ pre-event psychological status was fragile and impacted her work function. The index event worsened a pre-existing clinical level psychiatric disorder. There is link with work related stressors, although the direction of causation is unclear. I cannot conclude that the greater portion of her psychological impairment arises from the work related aggravation. The pre-existing condition and the work related injury had substantial impacts; one is not greater than the other.”
In Quintiliani-Johns her Honour sets out the extensive history of caselaw concerning s 323 of the 1998 Act, including the three step test outlined in Cole v Wenaline Pty Ltd [2010] NSWSC 78 and Elcheikh v Diamond Formwork (NSW) Pty Ltd (in liq) [2013] NSWSC 365 (Elcheikh) and the decisions following after.
Aspects of this ground of appeal have been discussed above, including the application of cl 11.10 of the Guidelines per Marks No 2 and her Honour’s commentary in Quintiliani-Johns.
The first aspect of the appellant’s submission (or ground) is that the Medical Assessor made a factual error regarding the diagnosis of the worker prior to her work related injury. The appellant disputes the diagnosis of bipolar disorder type 1. The appellant submits that the worker had pre-existing bipolar disorder type 2, and that there is no evidence that the worker’s role and function was impacted leading up to the injury, which commences on 20 March 2019. The appellant submits that the behaviour relied upon to find a significant pre-existing impairment is behaviour that occurred after the worker’s injury.
This aspect of the appellant’s submissions was specifically addressed in Quintiliani-Johns:
“By these paragraphs, the Appeal Panel addressed the factual issue that the plaintiff had raised. The plaintiff does not contend on this application that it was not open to the medical assessor to diagnose the plaintiff with bipolar disorder type 1 and does not challenge the Appeal Panel’s finding to that effect.”
The Appeal Panel note a significant history of psychological disorder for a period of over 20 years, including ongoing medication and a fluctuating and at times florid mental state. The appellant’s submissions put significant weight on the diagnosis made by the Medical Assessor, which was a conclusion available on the evidence. The Medical Assessor has appropriately considered the available medical evidence to reach a conclusion that Ms Quintiliani-Johns suffered from a pre-existing condition or abnormality. Whether the pre-existing condition was diagnosable as Bipolar I or II disorder is a moot point as both a diagnosable pre-existing conditions. The appellant acknowledges this, and by definition in the diagnostic criteria of DSM5 and ICD both conditions require clinically significant or marked impairment in a domain of function as rated in the PIRS. This complies with the second step in the three-step test outlined in Elchiekh.
The second aspect or ground of appeal pursuant to s 323 concerns the extent of the deduction made. Here the appellant submits that the deduction ought to be 1/10^th, with reference to cl 11.10 of the Guidelines.
As discussed above, in Quintiliani-Johns it was accepted (in obiter) that the conclusion reached in Marks No 2 that cl 11.10 of the Guidelines is inconsistent with s 323 does not apply where the pre-existing condition is symptomatic. Plainly on the evidence available Ms Quintiliani-Johns was affected by a symptomatic pre-existing condition. Accordingly, cl 11.10 of the Guidelines applies to the application of s 323 and must be applied according to its terms. In making a deduction of one half, without applying the PIRS assessment methodology to the identified pre-existing condition, the Medical Assessor has applied incorrect criteria.
On that basis, the Appeal Panel determined that it was necessary to conduct a re-examination of the worker. Given the issues raised on appeal concerning the diagnosis of the worker’s pre-existing condition, and the appropriate application of cl 11.10 of the Guidelines, the Appeal Panel is of the view that it is not limited to the “starting point” of the assessment made by the Medical Assessor under the PIRS. This is consistent with Coca-Cola Europacific Partners API Pty Ltd v Pombinho [2024] NSWCA 19 at [86]:
“In any event, Ground 4 in my opinion suffices to bring the assessment of Mr Pombinho’s current whole person impairment within the scope of the grounds of appeal and hence within the jurisdiction of the Appeal Panel. That is because I accept the appellant’s submission that, in order to determine the impact of pre-existing injury on current whole person impairment, a comparative exercise was necessary and that it would be logically incoherent simply to begin the exercise from a fixed starting point (i.e., the 24% whole person assessment made by the Medical Assessor) and then separately to consider the extent to which pre-existing injury contributed to that whole person impairment (and then to apply that amount to the fixed starting point) without considering the starting point itself. The approach required by the Guidelines is a subtractive approach, requiring a deduction from the starting point of whole person impairment but it would make the exercise artificial if, having been required to consider all of the material that the Medical Assessor had failed to consider, the Appeal Panel could not then revisit the starting point of the assessment.”
Accordingly, in conducting an assessment on re-examination, the Appeal Panel have considered all of the PIRS in respect of Ms Quintiliani-Johns’ pre and post-injury functioning.
The report of the Medical Assessor member of the Appeal Panel is as follows:

“REPORT OF THE EXAMINATION BY MEDICAL ASSESSOR

MEMBER OF THE APPEAL PANEL

Matter Number:	M1-W1418/23
Appellant:	Flavia Quintiliani-Johns
Respondent:	Secretary, Department of Education
Date of Determination:	09 February 2025

Examination Conducted By:	John Lam-Po-Tang
Date of Examination:	09 February 2025

1. The worker’s medical history, where it differs from previous records
Ms Quintiliani-Johns advised she initially began working at Callaghan College in 2002, as a science teacher in the junior campus of the school. She was taking an antidepressant medication, venlafaxine, at the time of commencement. She began working as a full-time teacher-librarian at the Jesmond campus of the college in 2009. She remained on venlafaxine at that point.
Around 2014, Ms Quintiliani-Johns began to salary sacrifice a portion of her usual wage in order to take a year's paid sabbatical in 2018. She explained that four years' of salary sacrifice were required to allow her to be paid throughout 2018. During these years, she reported no specific issues with work, and estimated she may have taken up to 2 or 3 days of sick leave per year. In October 2017, a new Principal commenced at Callaghan College.
During 2018, Ms Quintiliani-Johns did not work, and spent some of her time travelling. She went on a cruise for about a week as part of a small group. She spent 4 weeks travelling with one of her daughters in Sri Lanka; her husband joined them for a fortnight. She and her husband spent an estimated 8 - 9 weeks travelling in Europe, including Spain and Italy, where she visited her ancestral village and caught up with family. She remained on venlafaxine during this time, and noted her mood as follows: ‘I was happy, I was excited, I was looking forward to things’. She advised that she shared planning and organisation for the trip with her husband, but estimated she made most of the plans. She said that she was able to use public transport whilst abroad. She denied experiencing mood symptoms that restricted or limited activities.
In October 2018, Ms Quintiliani-Johns returned to Australia. She commented that as the weather was warm, she was able to go swimming on a regular basis, and was regularly attending yoga classes at a local studio. She reported being able to catch up with friends and family for gatherings and meals. She advised she was able to read books, both fiction and non-fiction, with a preference for the latter. She reported no problems with activities of daily living or self-care, and was cooking the majority of meals for the household. She added, ‘I loved my garden, I kept my garden really good (sic)... fruit trees and veggies’.

By the end of 2018, Ms Quintiliani-Johns reported, ‘I was refreshed and looking forward to getting back to work’.
In January 2019, Ms Quintiliani-Johns resumed working in her substantive position at the Jesmond Campus. She was not sure of the exact date she first returned to the school, initially stating it was in late January. She could not recall if she returned prior to the official start of the year for teachers.
On 17 January 2019, Ms Quintiliani-Johns was referred by a general practitioner, not her usual one (Dr Milton Sales) to the Emergency Department of James Fletcher Hospital in Newcastle. She was referred with insomnia for at least 4 days, elevated anxiety, and impaired capacity to undertake usual home duties, in the context of her brother's ill health and impending return to work. She was assessed but not admitted. The correspondence from hospital confirms the date of presentation, with a provisional diagnosis of Bipolar II Disorder and Generalised Anxiety Disorder. She was advised to commence a mood stabiliser, sodium valproate, and an antidepressant medication, mirtazapine, in addition to venlafaxine 450 mg daily. Ms Quintiliani-Johns could not recall details of this presentation to hospital, and initially queried whether it occurred in January 2019, or in early 2020. She commented, ‘I don't recall that, I'm sorry’. She was unable to state whether this presentation occurred prior to, or after, any contact or communication from her employer or school principal in 2019.
Ms Quintiliani-Johns advised that upon returning to Jesmond College, the Principal told her that the library was moving from its purpose-built 2-storey location, to a much smaller single-room space. She noted, ‘I never saw that coming’. She alleged that the Principal went on leave immediately after notifying her of this. She then sought advice from someone from the Department, who visited the school and made some suggestions. The Deputy Principal assumed responsibility for directing Ms Quintiliani-Johns's activity vis-a-vis the move.
Ms Quintiliani-Johns remained uncertain as to the chronology of events, that is, whether the hospital presentation on 17 January 2019 pre-dated the notification of library changes, or vice versa.
2.   Additional history since the original Medical Assessment Certificate was performed
The original Medical Assessment Certificate was based on an assessment on 21 June 2023.
Ms Quintiliani-Johns reported continuous psychiatric symptoms since June 2023, describing some mild variability in mood symptoms, describing her mood as anxious and depressed. She denied any periods of two weeks or longer where her mood was euthymic, and denied any periods of elevated mood.
When assessed in June 2023, Ms Quintiliani-Johns was prescribed lamotrigine 175 mg daily. Since that time, the dose has been increased to 200 mg daily, but she could not recall when this occurred. She advised that at some stage, the dose was increased above 200 mg daily, but could not recall the specific dose. She took the higher dose for 2 weeks, but experienced side effects, and reduced the dose back to 200 mg daily. She has been prescribed quetiapine at some stage since June 2023, but could not recall when this was commenced.
Ms Quintiliani-Johns's medications at the time of the current evaluation were lamotrigine 200 mg daily and extended-release quetiapine 100 mg nightly. She reported no as-needed medication.
Ms Quintiliani-Johns continued to receive treatment from the Hunter New England Local Health District (HNE LHD) in the second half of 2023. She was discharged from community mental health care in late 2023, and began consulting psychiatrist Dr Catherine Faehrmann again, as well a new psychologist, Mr Stewart Oxley. She denied any re-referral back to the community mental health team since her discharge.
In early 2024, Ms Quintiliani-Johns and her husband planned a visit to 2 of their daughters, one of whom lives in Coffs Harbour, the other in Kingscliff. She advised they had planned a number of days away, but after 3 nights, she felt unable to continue with the visits, and returned home. She commented, ‘We got to both [daughters], but it was really rushed’. Whilst visiting her daughters, Ms Quintiliani-Johns went out for breakfast on at least one occasion, and walked around Kingscliff.
In the first half of 2024, Ms Quintiliani-Johns and her husband were booked for a 2-week holiday in The Philippines. Her husband and daughter undertook the planning over several months. They were meant to depart in either May or June 2024, and Ms Quintiliani-Johns recalled, ‘The day before we were to go, I got stressed and had to cancel’. She elaborated, ‘I got overwhelmed about packing... all those sorts of things’. She commented that her husband was frustrated by this.
In August 2024, Ms Quintiliani-Johns, her husband and one of their daughters went on a 2-week holiday to Vietnam, explaining that both she and her daughter had their birthdays at this time. They spent time in Ho Chi Minh City and Hanoi. Ms Quintiliani-Johns recounted, ‘I didn't want to go out much out of the hotel’, estimating she stayed in about half the time. She recalled going to see some kind of circus performance and visiting a museum whilst in Ho Chi Minh City, and in Hanoi, advised she walked by a river and in the city. She advised she would have breakfast in the hotel; lunch and dinners were taken away from the hotel. She went to dinner for her daughter's birthday, but couldn't recall what they did for her birthday. On the days her husband and daughter left the hotel, Ms Quintiliani-Johns advised she spent time by herself, either in the hotel lobby, or her room. She described her mood as "a bit better" when in Vietnam, but denied substantial improvement therein.
In November 2024, Ms Quintiliani-Johns consulted Dr Faehrmann, who prescribed her an antidepressant medication, escitalopram. Potential cardiac side effects were discussed, and Ms Quintiliani-Johns was advised to have an ECG prior to commencement. She advised she got anxious about side effects, did not end up organising an ECG, and did not start escitalopram.
Over the end-of-year holiday period, Ms Quintiliani-Johns's 3 children came to visit at stay with her, each child spending at least 2 nights at their home. She said she found these visits stressful, specifically citing the need to organise bedding and groceries as reasons for this. Ms Quintiliani-Johns spent Xmas Day at her sister-in-law's home, estimating she spent around 2 or 3 hours there with family members. She said that her husband had suggested going to see the fireworks on New Year's Eve, however, she declined to go.
Ms Quintiliani-Johns explained it was her wedding anniversary on 19 January 2025, and that her husband suggested ways in which this could be celebrated. She declined suggestions to go to lunch, to have a picnic, or to go to dinner. She advised they ordered takeaway food for their meal.
On 6 February 2025, Ms Quintiliani-Johns consulted Dr Faehrmann, who encouraged her to commence taking escitalopram.
Ms Quintiliani-Johns denied any of the following since June 2023: manic or hypomanic episodes, psychotic symptoms, deliberate self-harm, hospital presentations for psychiatric or other reasons, psychiatric admissions, periods of non-compliance with medication, taking any other psychotropic medications that have subsequently been ceased, diagnosis with a new medical or surgical condition, or sustaining a head injury.
3.   Findings on clinical examination
Ms Quintiliani-Johns presented as a woman of stated age, of European background. She wore a sleeveless top, glasses and had long hair. She was co-operative throughout the assessment. She became anxious and flustered during the two periods of technical difficulties with the video-conferencing platform, and was apologetic about these. She made eye contact through the platform. There was no psychomotor disturbance observed.
Ms Quintiliani-Johns's speech was hesitant, soft to normal in volume, and normal to slow in rate. There were some pauses prior to answering questions. When speaking about the circumstances leading to cessation of work, she spoke more rapidly. Her affect was restricted in range, and she did not smile at any time. She was tearful on several occasions. Her affect was congruent with subject matter. Her mood was subjectively and objectively depressed and anxious. There was no formal thought disorder. Her responses varied in the degree of elaboration and detail - there was no consistent poverty of ideation or overinclusiveness. No delusional thought content was expressed or observed. Ms Quintiliani-Johns denied suicidal ideation or intent, but disclosed intermittently thinking about ‘not wanting to be here’.
Cognitively, Ms Quintiliani-Johns did not present as drowsy at any stage of the interview, and no fluctuation in level of consciousness was observed at any stage. She displayed impairment in both short-term and long-term memory. Whilst transient impairment in concentration was noted, she was able to persist with the interview, which lasted over 2 hours (breaks excluded).
4.   Results of any additional investigations since the original Medical Assessment Certificate
Not applicable
Functional assessment prior to March 2019
For around 15 months prior to March 2019, Ms Quintiliani-Johns was on a planned sabbatical. Thus, she did not work from December 2017 until returning to work in January 2019.
Ms Quintiliani-Johns reported no impairment in activities of daily living prior to March 2019, commenting she would ‘shower every day’, attend to dental hygiene on a regular basis, and have her hair cut every 6 - 8 weeks. She advised she would cook "most of the meals" of the household. She commented, ‘I loved my garden; I kept my garden really good (sic)... fruit trees and veggies’.
Notwithstanding Ms Quintiliani-Johns's description of function in the home setting, the discharge summary from James Fletcher/Mater Mental Health Service (17 January 2019) records a 4-week period of worsening anxiety and insomnia, with a 4-day period of marked worsening of social functioning and capacity to undertake usual home duties, with impaired concentration and fatigue being recorded.
Additionally, on 21 January 2019, a letter of referral from Dr Bridget Daniel, general practitioner, recommends referral to a private psychiatric facility, Warners Bay Private Hospital, however, the degree of urgency is recorded as "low". Symptoms recorded in this letter include difficulty coping, insomnia, reduced food intake, difficulty making decisions. Her mood is described as ‘severely depressed’, with ‘Poor judgement and no insight’ reported.
A further letter, by regular GP, Dr Milton Sales, dated 6 February 2019, is a referral to Dr Catherine Faehrmann, consultant psychiatrist, with symptoms listed: ‘low mood, anxiety, sleep disturbance, with self harm thoughts’
Ms Quintiliani-Johns advised that she engaged in social activities on a regular basis prior to March 2019, including regular gatherings with her in-laws, and social visits to other relatives. She advised that she regularly caught up with friends for activities such as dinner. She advised she attended a yoga studio at least weekly, and from October 2024 onwards, after returning from an overseas trip, was swimming regularly at a local ocean pool.
During 2018, Ms Quintiliani-Johns undertook significant amounts of travel, as outlined above, an estimated 14 weeks away from home. Travel included unfamiliar overseas destinations. Ms Quintiliani-Johns asserted that she undertook travelling planning and reservations for these trips. She was able to drive alone in her car, without restriction. Whilst overseas, she was able to use a range of public transport options, including trains and buses. She was also able to undertake long-haul flights. She was accompanied on her overseas trips.
Ms Quintiliani-Johns reported a good relationship with her husband and family in the year leading up to March 2019. This is not substantially changed in the present time. She reported socialising with her in-laws on a weekly basis; the current frequency of this is less than once a month. She advised she socialised regularly with friends, but does not do so at present.
Ms Quintiliani-Johns denied any specific problems with her concentration in general in the year leading up to March 2019. She advised she was able to read both fiction and non-fiction books.
Occupationally, Ms Quintiliani-Johns did not work at all during the 2018 school year. She resumed working on a full-time basis in January 2019, and advised she worked on a full-time basis throughout the 2019 school year.
Functional assessment at the time of the current evaluation
Ms Quintiliani-Johns advised she does not bathe daily, especially if she is not leaving her home. She estimated attending to dental hygiene 3 - 4 times per week. She washes her hair once a week. She last had her hair cut in October 2024. Her husband prompts her to attend to personal hygiene.
Ms Quintiliani-Johns is able to remain at home alone ‘most of the time’, when her husband is at work, typically from 07:30/08:00 to 16:00/16:30. Twice within the past 12 months, Ms Quintiliani-Johns's husband has travelled away from the home for 1 or 2 nights, leaving her alone at home.
Ms Quintiliani-Johns usually eats twice a day, sometimes once. Her husband reminds her to have dinner, and does most of the cooking. She is able to prepare a meal ‘maybe once a week’, putting a pizza in the oven, or making chicken with a salad.
Around the home, Ms Quintiliani-Johns does the dishes or loads the dishwasher. She cleans the bathroom around once a fortnight.
Self-care & personal hygiene rating: 2
Ms Quintiliani-Johns advised she does self-directed yoga at home twice a week for 15 - 30 minutes; she does not go to a yoga studio. She goes to a local ocean pool with her husband once a week for 30 - 60 minutes. She goes walking with her husband once a fortnight for 40 - 50 minutes. She walks alone around her neighbourhood once a week, for around 25 minutes.
In early 2024, went on a trip to visit daughters in northern NSW, but terminated the visit early, after 3 nights, having planned to spend a longer period of time away. Whilst away, she went out at least once for breakfast with her family, and walked around Kingscliff.
At Xmas 2024, Ms Quintiliani-Johns spent 2 - 3 hours with family members at lunch. She does not go out to restaurants or registered clubs in her area. Whilst overseas for 2 weeks in August 2024, she did have meals in restaurants and engaged in some sightseeing on about half the days. She may watch rugby league on TV when the Newcastle Knights are playing, but does not go to games.
Social & recreational activities rating: 3
Ms Quintiliani-Johns is able to drive alone to appointments, doing so fortnightly. Usually her husband either drives or accompanies her. She reported venturing to known locations.
In May/June 2024, Ms Quintiliani-Johns cancelled a planned trip to the Philippines with her husband, at short notice. In August 2024, Ms Quintiliani-Johns, her husband and one of her daughters travelled to Vietnam for 2 weeks.
Travel rating: 2
Ms Quintiliani-Johns remains in her marital relationship, with no reported periods of separation. She maintains relationships with her adult children. Her children visited her over the Xmas 2024 period. She has some contact with her in-laws, albeit less than previously. There was no evidence of intra-familial relationships being severely strained. She has lost friends she knows from work, and actively avoids any contact with former work colleagues.
Social functioning rating: 2
Ms Quintiliani-Johns advised she does not read. She gets distracted whilst watching TV with her husband. She could recall the last TV show she watched. Several weeks prior to the assessment she was reversing out of her garage and clipped a side mirror; this has happened several times previously. She advised she has occasionally forgotten where she has parked her car in a multistorey carpark.
Ms Quintiliani-Johns advised she cannot follow recipes suggested to her by her husband and family, and that she misses steps. She advised she has burnt food whilst cooking.
Concentration, persistence & pace rating: 3
Ms Quintiliani-Johns has not worked in any paid or voluntary capacity since 2021. Ms Quintiliani-Johns's description of tasks and activities undertaken inside or outside of her home were not consistent with income-generating activities.
Employability rating: 5
Summary
Ms Quintiliani-Johns is a 58 year old former teacher-librarian, who has not worked in any capacity since April 2021. She is job detached. She has a diagnosis of Bipolar I Disorder, the basis of which is one manic episode with psychotic features, requiring involuntary hospitalisation in February 2022.
A history of treatment with high-dose antidepressant treatment for more than 20 years prior to March 2019 is noted. It is additionally noted that in January 2019, based on reported periods of elevated mood by Ms Quintiliani-Johns's husband, she was diagnosed with Bipolar II Disorder by the James Fletcher/Mater Mental Health service.
Ms Quintiliani-Johns reported persistent symptoms of depression since her period of hospitalisation in early 2022. This is consistent with reported symptoms during an independent medical examination by Dr Cassimatis, dated 25 October 2022, and with the reported psychiatric symptoms when assessed by Medical Assessor Clayton Smith in June 2023. These symptoms have persisted despite prescription of a mood stabiliser, lamotrigine, at a high dose (200 mg daily) and an antipsychotic medication, quetiapine, at a low dose (100 mg nightly). She has been advised to commence an antidepressant medication by her treating psychiatrist, but has not yet done so. “

The Appeal Panel agree with and adopt the report of the Medical Assessor member of the Appeal Panel.
In respect of s 323 of the 1998 Act, the evidence of a symptomatic pre-existing psychiatric condition is undeniable. On 17 January 2019, a discharge summary from the James Fletcher/Mater Mental Heal Service records a four week period of worsening anxiety and insomnia, with an impact on functioning. On 21 January 2019, Ms Quintiliani-Johns’ general practitioner recommend that she be referred to a private psychiatric facility, with significant psychiatric symptomatology. A further letter on 6 February 2019 also described psychiatric symptoms. These records predate the date of commencement of the events at work from 20 March 2019, as set out in the appellant’s submissions and as pleaded in the Application to Resolve a Dispute. The above is in addition to the 20 year history of depression requiring significant and continuous pharmacological treatment.
Having determined that Ms Quintiliani-Johns suffered from a symptomatic pre-existing condition, the Appeal Panel must determine, per step 3 in Elchiekh, the extent of contribution from that condition. Consistent with the decision in Quintiliani-Johns, that must be in accordance with cl 11.10 of the Guidelines.
Although the Medical Assessor member of the Appeal Panel who conducted the re-examination took a thorough history of Ms Quintiliani-Johns’ functioning prior to the work-related injury, it is the Appeal Panel’s view that it is not possible to assess Ms Quintiliani-Johns in accordance with the PIRS. Ms Quintiliani-Johns had poor recall for some clearly documented health events during the time, including her hospital assessment in January 2019. It is not possible to rely on Ms Quintiliani-Johns’ recall of her functioning reliably (that is not to say that she is deliberately obfuscating her history. Her lack of recall is likely a function of her psychiatric illness and the period of time that has elapsed since 2019).
In accordance with the final sentence of cl 11.10, the Appeal Panel find that the percentage of pre-existing impairment cannot be assessed and make a deduction of 1/10^th of the assessed permanent impairment. This is consistent with s 323(2) of the 1998 Act. That deduction is not at odds with the available evidence which the Appeal Panel have considered in detail, as set out above. Further, as the appellant points out, the consistent medicolegal opinion in that regard is a deduction of 1/10^th being appropriate.

Conclusion

The re-examination findings provide an ascending impairment of 2, 2, 2, 3, 3, 5. This is a mean of 3 and an aggregate score of 17. This is converted into a whole person impairment of 19%, before a deduction of 1/10^th is applied for a final whole person impairment of 17%.
Accordingly, the MAC will be revoked and replaced with a new MAC, as set out below.

WORKERS COMPENSATION DIVISION

APPEAL PANEL

MEDICAL ASSESSMENT CERTIFICATE

Injuries received after 1 January 2002

Matter number:	W1418/23
Applicant:	Flavia Quintiliani-Johns
Respondent:	Secretary, Department of Education

This Certificate is issued pursuant to s 328(5) of the Workplace Injury Management and Workers Compensation Act1998.

The Appeal Panel revokes the Medical Assessment Certificate of Medical Assessor Clayton Smith and issues this new Medical Assessment Certificate as to the matters set out in the Table below:

Table - whole person impairment (WPI)

Body Part or system	Date of Injury	Chapter, page and paragraph number in NSW workers compensation guidelines	Chapter, page, paragraph, figure and table numbers in AMA 5 Guides	% WPI	Proportion of permanent impairment due to pre-existing injury, abnormality or condition	Sub-total/s % WPI (after any deductions in column 6)
Psychiatric	21 April 2021 (deemed)	Ch 11	19%	1/10	17%
Total % WPI (the Combined Table values of all sub-totals)					17%

[2025] NSWPICMP 158

12 March 2025